Download Catheter-associated bloodstream infections

OPERATIONAL DEFINITION
MEASUREMENT: Nosocomial Infection Rates: Bloodstream Infections per 1000
Catheter Days
I. Description and Rationale
This measure answers the question:
How often do patients contract an infection as a result of Central Venous Catheter (CVC)
or Peripherally Inserted Central Catheters (PICC) insertions or maintenance practices?
Bloodstream Infections are assessed according to definitions published by the National
Healthcare Safety Network [NHSN]) of the Centers for Disease Control and Prevention
(CDC). This measure is the number of CVC or PICC associated laboratory confirmed
bloodstream infections (LCBI’s) per 1000 catheter days. The data are collected housewide for patients with one or more CVCs or PICCs. To be counted, an infection must not
be incubating at the time of admission. For most infections, this means that the infection
does not become evident until 48 hours or more after admission, but each infection must
be assessed individually.
II. Population Definition (Inclusions/Exclusions)
Collected house-wide for patients with a CVC or PICC
Analyzed and reported separately for CCHMC house-wide, RCNIC, CICU, PICU,
A5N2, A5S, B5E, and B5W.
Infection must not be incubating at the time of admission into the hospital. For most
infections, this means that the infection does not become evident until 48 hours or
more after admission, but each infection must be assessed individually.
III. Data Source(s)
Dr. Beverly Connelly, CCHMC Division of Infectious Diseases
IV. Sampling and Data Collection Plan
Numerators: The following methods are used to determine infections:
1) For ICU patients, there is a daily review of patient charts for any indications that there
might be an infection, and appropriate steps taken to identify and/or confirm, based on
what is found in those reviews.
2) For both ICU and non-ICU patients, Infection Control will be alerted to any positive
results from blood cultures ordered by the physicians. In such cases, Infection Control will
also review the corresponding patient charts to check for any additional information or
indications.
James M. Anderson Center for Health Systems Excellence Last Updated: 11/9/2011 Contact: Art Wheeler
©2007-2008, Cincinnati Children's Hospital Medical Center
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3) Discharge codes are reviewed for all patients for indication of any infections not
previously identified.
Denominators: CVC and PICC line days are provided to Infection Control monthly, from
the CVC Resource Nurses, who make a daily count all of the lines.
V. Calculation
Numerator: Number of patients contracting an infection, as defined by CDC guidelines.
Multiple infection sites due to the same organism are counted as one infection. For this
measure, distinction is not made between an infection due to CVC/PICC insertion and
one due to maintenance practices.
Denominator: Total number of catheter days during the time period.
Nosocomial Infection Rate = (Numerator/Denominator)*1000
VI. Analysis Plan and Frequency of Reporting
Data is collected monthly. It is analyzed and reported separately for CCHMC house-wide,
RCNIC, CICU, PICU, A5N2, A5S, B5E, and B5W.
VII. Reporting Venues
Reported quarterly on the CCHMC Hospital Scorecard under “Health Care Delivery”
R reported monthly on the Inpatient CSI Dashboard
Monthly control charts are posted on Centerlink under Strategic Improvement
Priorities Reports and under Patient Safety.
VIII. Limitations
Does not distinguish between infections due to CVC insertion and infections due to
CVC maintenance practices. Catheter days as a denominator may not be as effective
for Infections due to CVC insertion.
X. Experts/Resources
Centers for Disease Control (CDC) – National Healthcare Safety Network [NHSN]):
definitions are available for download at…
http://www.cdc.gov/ncidod/dhqp/pdf/nnis/NosInfDefinitions.pdf
CDC NNIS System. National Nosocomial Infections Surveillance (NNIS) System
report, data summary from January 1992 through June 2003, issued August 2003.
Jarvis W. R., Benchmarking for Prevention: The Centers for Disease Control and
Prevention’s National Nosocomial Infections Surveillance (NNIS) System Experience.
Infection 31:2003 Supplement 2.
XI. Revision History
Version
Draft
Revision 1
Revision 2
Primary
Author(s)
AMA
AMA
TAW
Description of Version
Reformatted
Amended Description and Analysis Plan
Date
Completed
06/03/2004
02/09/2005
06/23/2006
James M. Anderson Center for Health Systems Excellence Last Updated: 11/9/2011 Contact: Art Wheeler
©2007-2008, Cincinnati Children's Hospital Medical Center
Page 2
Version
Revision 3
Revision 4
Primary
Author(s)
TAW
TAW
Description of Version
Added mention of Individual Units
Expanded Sampling and Data Collection Description
Updated NNIS references to NHSN
Date
Completed
06/29/2006
09/11/2008
James M. Anderson Center for Health Systems Excellence Last Updated: 11/9/2011 Contact: Art Wheeler
©2007-2008, Cincinnati Children's Hospital Medical Center
Page 3